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Thread: question for Fes bike users

  1. #1
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    question for Fes bike users

    All the publicity about Christopher Reeve has brought up for me again the question of whether or not to pursue Fes bike therapy. As I understand it, the benefits of Fes biking only take place if you do it for a minimum of three times a week. From previous postings, it's clear that setting up and recovering from the bike take at least 90 minutes total. That makes fes therapy quite a commitment! I think I could do it if the aerobic portion of it made me feel better, like running did before my injury. So my question to you folks that use the Fes bike: is a pleasurable experience?, does getting your heart going faster improve your mental outlook and feelings of well-being?, do you look forward to it like going for a conventional bike ride or jog?

  2. #2
    Member Fritsch's Avatar
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    There is not much that compares with going for a run but the fes bike is close. I hadnt heard that the effectiveness is good only if you use iit 3x per week however if you do less it iis difficult to build endurance. I set it up so i dont need an assistance and its just my time to exercise. it feels good to geet the body going again.. especially if i have adeima or just that feeling my heart rate needs a jump.

  3. #3
    I don't have it like at home yet, still fighting with my insurance. I have used one and been evaluated at a local rehabilitation facility. Just to see your legs moving again and knowing that they are actually doing the work is an amazing feeling. My wife and mom had tears in there eyes the first time they saw me on the bike. I haven't been on it enough to know a lot about the physical effects, but it does give some cardiovascular workout.

  4. #4
    Senior Member Jeff's Avatar
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    My first year with the bike was awesome

    After that it has gotten rather tedious for me. I'm guilty of letting it go too long in between rides. I only rode once per week for a couple months.

    My wife has recently become my trainer [nagger] however, and I'm starting to do a lot better. I was getting out of my car recently with Wise holding my chair to be helpful when spasticity started hampering my transfer. My wife spoke up, "Honey, you're so lazy - you need to ride your bike more." Maybe my wife was hoping by mentioning it in his presence it would have more effect on me.

    Well, I did my first three ride week in a while this week, so my spasticity is low again. I feel MUCH better about myself. I'm also going to inquire about getting upgraded to the newer software which should give me the same effect with less pain [I'm incomplete enough that it can really hurt].

    It is a big time commitment if you work a full-time job. It's easy in the beginning but takes a lot of discipline, for me at least, after you get past the newness. But I highly suggest it for all.

    ~See you at the SCIWire-used-to-be-paralyzed Reunion ~

  5. #5
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    cost

    how much does it cost and does medicare pay for it? thanks

    andy m nguyen

  6. #6
    sventstr, I don't know the answer to your question but here are some studies on the subject:

    • Leeds EM, Klose KJ, Ganz W, Serafini A and Green BA (1990). Bone mineral density after bicycle ergometry training. Arch Phys Med Rehabil. 71 (3): 207-9. Summary: The effect of functional electrical stimulation (FES) cycle ergometry on bone mineral density (BMD) was investigated in six spinal cord injury (SCI) quadriplegic men. Each subject trained three days a week for six months on an FES cycle ergometer. Pretraining and posttraining BMD measurements of the proximal femur were performed using dual photon absorptiometry. Mean pretraining BMD (percent norm) for the femoral neck, Ward triangle, and trochanter were 66.65, 57.43, and 57.67, respectively. After six months of FES cycle ergometry, mean BMD measurements were 66.15, 57.07, and 55.13, respectively. There was no statistically significant difference between the pretraining and posttraining BMD measurements. All subjects were found to have osteoporotic proximal femurs when BMD was expressed as a percent of their age-matched controls. Bone mineral density measurements were subsequently performed on three additional men with SCI who had exercised for three years with the FES cycle ergometry modality. Their mean BMDs were not significantly different from the experimental group. This study demonstrated that six months of FES cycle ergometry did not produce an increase in BMD. University of Miami School of Medicine, FL.
    • Mohr T, Dela F, Handberg A, Biering-Sorensen F, Galbo H and Kjaer M (2001). Insulin action and long-term electrically induced training in individuals with spinal cord injuries. Med Sci Sports Exerc. 33 (8): 1247-52. Summary: PURPOSE: Individuals with spinal cord injuries (SCI) have an increased prevalence of insulin resistance and type 2 diabetes mellitus. In able-bodied individuals, training with large muscle groups increases insulin sensitivity and may prevent type 2 diabetes mellitus. However, individuals with SCI cannot voluntarily recruit major muscle groups, but by functional electrical stimulation (FES) they can now perform ergometer bicycle training. METHODS: Ten subjects with SCI (35 +/- 2 yr (mean +/- SE), 73 +/- 5 kg, level of lesion C6--Th4, time since injury: 12 +/- 2 yr) performed 1 yr of FES cycling (30 min x d(-1), 3 d x wk(-1) (intensive training)). Seven subjects continued 6 months with reduced training (1 d x wk(-1) (reduced training)). A sequential, hyperinsulinemic (50 mU x min(-1) x m(-2) (step 1) and 480 mU x min(-1) x m(-2) (step 2)), euglycemic clamp, an oral glucose tolerance test (OGTT), and determination of GLUT 4 transporter protein in muscle biopsies were performed before and after training. RESULTS: Insulin-stimulated glucose uptake rates increased after intensive training (from 4.9 +/- 0.5 mg x min(-1) x kg(-1) to 6.2 +/- 0.6 mg x min(-1) x kg(-1) (P < 0.008) [step 1) and from 9.0 +/- 0.8 mg x min[-1) x kg[-1) to 10.6 +/- 0.8 mg x min[-1) x kg[-1) [P = 0.103) [step 2)). With the reduction in training, insulin sensitivity decreased to a similar level as before training [P > 0.05). GLUT 4 increased by 105% after intense training and decreased again with the training reduction. The subjects had impaired glucose tolerance before and after training, and neither glucose tolerance nor insulin responses to OGTT were significantly altered by training. CONCLUSIONS: Electrically induced bicycle training, performed three times per week increases insulin sensitivity and GLUT 4 content in skeletal muscle in subjects with SCI. A reduction in training to once per week is not sufficient to maintain these effects. FES training may have a role in the prevention of the insulin resistance syndrome in persons with SCI. Department of Medical Physiology, The Panum Institute, University of Copenhagen, Copenhagen, Denmark. t.mohr@dadlnet.dk.
    • Mulder AJ, Hermens HJ, Janssen F and Zilvold G (1989). A low-cost FES exercise bicycle for training paraplegics at home. J Med Eng Technol. 13 (1-2): 90-2. Summary: The success of FES exercise programmes for training paraplegic muscles at home depends highly upon the availability of reliable, easy-to-use and inexpensive training equipment. For endurance training, FES bicycle exercisers are well accepted. However, they are not suited for home use due to the high expense of commercially available equipment. This paper describes the development of a FES exercise bicycle for use at home. It consists of a standard bicycle ergometer with minimum modifications. The exerciser can be used by the patient sitting in the wheelchair, and may be used with any two-channel muscle stimulator. Rehabilitation Centre Het Roessingh, Enschede, The Netherlands.
    • Pacy PJ, Evans RH and Halliday D (1987). Effect of anaerobic and aerobic exercise promoted by computer regulated functional electrical stimulation (FES) on muscle size, strength and histology in paraplegic males. Prosthet Orthot Int. 11 (2): 75-9. Summary: The influence of anaerobic and aerobic exercise, promoted by computer regulated functional electrical stimulation (FES) was evaluated in four paraplegic males. Quadriceps muscle bulk was monitored by serial computerised axial tomography (CT) scanning and histology by muscle biopsies from the vastus intermedius. Anaerobic exercise consisted of 60 degree straight leg raising against increasing weights (range 1.4-11.4 kg) over a period of ten weeks. Aerobic exercise consisted of pedalling a modified Monark bicycle ergometer at 50 rpm against a fixed load ranging from 0-3/8 kilopond (0-18.75 watts) over a period of eight months. In both exercise studies the same work was not achieved by each paraplegic. FES was regulated by a closed loop system which is not presently commercially available, the frequency of the sequential muscle stimulator was 40 Hz with a pulse width of 300 microseconds. Quadriceps muscle area of both legs increased 62.7% (p less than 0.01) after anaerobic exercise; similar but less pronounced effects followed aerobic exercise. Histologically two distinct patterns were noted from the outset, one had normal fibre type distribution the remainder had marked Type 1 loss. Both exercise regimens failed to change these although the number of internal nuclei per 100 fibres steadily increased (from 7.0% to 13.8% to 26.0%) as did the % of fibres with internal nuclei (5.4% to 10.5% to 25.7%) throughout the exercise periods. The significance of these observations is not immediately apparent but may signify continuing damage which may be due to the eccentric rather than the concentric nature of FES promoted muscular contraction. Nutrition Research Group, Clinical Research Centre, Harrow, United Kingdom.

  7. #7

    Using FES bike

    svenstrs - As a coordinator of a CFES program for 10 years, I can only offer positive reviews based upon my observations and the reports of my patients, many of whom have been using the bike for over 15 years. Let me specifically address each of your questions:

    1) Frequency of use: ideally, the program is designed for long term continuous therapy, 3 times per week, 30 minutes per session. Many of my patients work or go to school. They initially started with the above schedule, but have needed to reduce the frequency due to scheduling. I believe, the important outcome is in the consistency of using the bike. As noted in one of the posts, riding 3x per week with increasing resistance does increase endurance. However, my observations indicate that over time cycling one or two times per week is also beneficial.

    2) Set-up - The time for this varies with the type of electrode application and the level of injury. If one uses a one piece garment, with the electrodes sewn in, it is a very quick and efficient application process. Most of my paraplegics can set themselves up and total time for one session is about one hour maximum. For a quadriplegic, a session with no problems, can be done in about 1 1/2 hours.

    For persons who work, many prefer to do a session right after getting up, get off the bike, hop in the shower and on with the day's activities. I found that this also gave the person a boost of energy that was beneficial for the entire day. Some do their sessions in the evening due to work schedule, availability of attendant, etc. However, this can be more difficult as the person is already tired from a full day's schedule.

    3) Benefits and feelings - one C5/6 quad related the flow of oxygen through his lungs, similar to when he ran wind sprints as a football player; another talked about being more alert during the day and able to think more clearly; a mom with a young infant found she was able to face the daily challenges with more calm and assurance; a C7 quad finally had her blood pressure staying at a more appropriate level and was able to do her own housework, etc after a ergometry session.

    A small, informal study that I did over two years, using a tool that looked at mood states confirmed the very positive outlook and benefits reported above.

    Cauteo - Contrary to what many believe, many insurance companies will reimburse for this durable medical equipment. It is important to provide the correct supporting information and a statement of medical necessity to accompany any request or appeal of a denial of such request. Medicare will not purchase an ergometer but I was able to obtain medicare and medicaid (state of MD) reimbursement for clinic sessions using the ergometer. For costs, go to the websites of the two manufacturers: www.musclepower.com and www.electrologic.com

    Computerized functional electrical stimulation using a cycle ergometer is an exciting technology for persons with SCI; it has far-reaching benefits. CRF

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